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Neonatal brain MRI to prognosticate neurodevelopmental outcomes in fetal growth restricted infants: a systematic

Randy Ramdial¹, Madeline A MacNamara¹, Randal Moldrich^1,2

¹UQ Centre for Clinical Research, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia.

Frontiers in Pediatrics

|January 28, 2026

Insights

This study explored early magnetic resonance imaging (MRI) brain markers to predict neurodevelopment in fetal growth restricted (FGR) infants. Current evidence is limited, necessitating further research for reliable prognostic markers.

Area of Science:

Neonatal Neurology
Developmental Pediatrics
Neuroimaging

Background:

Fetal growth restriction (FGR) is associated with increased neurodevelopmental risks compared to appropriate for gestational age (AGA) infants.
Early identification of neurodevelopmental outcomes in FGR infants is crucial for timely intervention.
Magnetic resonance imaging (MRI) at birth may offer insights into potential developmental trajectories.

Purpose of the Study:

To identify magnetic resonance imaging (MRI) brain markers at birth that prognosticate neurodevelopmental outcomes at ≥12 months of age in fetal growth restricted (FGR) infants.
To systematically review existing literature on MRI markers for neurodevelopmental outcomes in FGR neonates.

Main Methods:

A systematic literature search was conducted across major databases (PubMed, Embase, CINAHL, Scopus) in March 2025.
Inclusion criteria focused on infants with birth weight <10th percentile, neurodevelopmental outcomes ≥12 months, and birth MRI scans, comparing FGR to AGA infants.
Study quality was assessed using the Cochrane-approved Quality in Prognosis Studies tool.

Main Results:

Three articles met the inclusion criteria, all showing correlations between brain MRI regions and neurodevelopmental outcomes.
Only one study specifically correlated early MRI findings with neurodevelopmental outcomes in FGR infants.
This single study reported a positive correlation between MRI total parenchyma area and cognitive scores in FGR infants.

Conclusions:

While FGR neonates show different MRI results associated with adverse neurodevelopmental outcomes compared to AGA infants, current evidence is insufficient to establish definitive MRI prognostic capabilities for FGR.
Further research, including sub-group analysis and advanced MRI techniques, is needed.
Robust clinical MRI markers for early adverse brain development in FGR newborns require further ascertainment.

Read full analysis

Abstract

Aim:

The purpose of this study was to identify magnetic resonance imaging (MRI) brain markers at birth that prognosticate neurodevelopmental outcomes at ≥12 months of age in fetal growth restricted (FGR) infants.

Methods:

A systematic literature search was undertaken in PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus in March 2025. Articles were assessed by two reviewers. The inclusion criteria included papers relating to infants with birth weight <10th percentile, with assessed neurodevelopmental outcomes at 12 months of age or older, and MRI performed at birth with markers for neurodevelopment, and comparison of data to appropriate for gestational age (AGA) infants. The quality of studies was assessed using the Cochrane-approved Quality in Prognosis Studies tool.

Results:

Three articles met the inclusion criteria. All demonstrated a correlation between MRI in regions of the brain and neurodevelopmental outcomes >12 months of age across all studied infants. However, only one of the three studies correlated early MRI results with neurodevelopmental outcomes specifically in FGR infants and thus a meta-analysis could not be performed. The single study reports a positive correlation between MRI total parenchyma area and cognitive scores in FGR infants.

Conclusion:

The current literature highlights the developmental risk in FGR vs. AGA infants. FGR neonates have significantly different MRI results compared to AGA neonates and MRI findings in the neonate are associated with adverse neurodevelopmental outcomes. However, current evidence is insufficient to firmly establish MRI prognostic capabilities specifically for FGR infants. Sub-group analysis of the FGR cohort in the reported studies and the use of more advanced MRI techniques would likely elucidate this. Further research is required to ascertain robust clinical MRI markers of early adverse brain development in the FGR newborn.

Systematic Review Registration:

identifier CRD42023400436.

Keywords:

brain fetal growth retardation intrauterine growth restriction magnetic resonance imaging neurodevelopment newborn

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